SECURITE EN ANESTHESIE AU SUD ET A L’EST DE LA RD CONGO : Etat de lieu et Perception communautaire
Abstract
Objective: To assess the current anaesthesia safety situation in the south and east of the Democratic Republic of Congo, with a view to reducing anaesthesia-related morbidity and mortality, and to evaluate the perception of safety within the local community.
Methodology: This is a descriptive cross-sectional study with an analytical component, using a mixed prospective approach (qualitative and quantitative) in 10 health facilities in the South and East of the DR Congo (CliniquesUniversitaires de Lubumashi, Centre MédicalDiamant, Hôpital SENDWE, Polyclinique Saint-Luc, Hôpital DACO, HGR de Mwangeji, HôpitalMéthodiste, HôpitalGénéral de Kadutu, HôpitalSkyborne and HPGR de Kalemie) located respectively in the towns of Lubumbashi (4 facilities), Likasi (1 facility), Kolwezi (2 facilities), Kalemie (1 facility) and Bukavu (2 facilities) during the period from September 2024 to February 2025 (approximately 6 months) on anaesthesia safety in the South and East of DR Congo: State of play and community perception. Safety in anaesthesia is captured through an evaluation of post-anaesthetic complications, patient satisfaction with care, the level of confidence expressed by the patient in anaesthetic care, and the willingness of patients to recommend others in the health establishments where they receive care. In addition, the variables of safety according to WHO recommendations are taken into account and include, among others, the qualification of the health care staff, the use of the checklist, the availability of and access to monitoring equipment and medicines, and the quality of the health care infrastructure meeting the standards. The level of community perception is captured through an analysis of expectations, attitudes and perception itself in relation to anaesthesia care. Sampling is probability based and determined by the Schwartz formula. A survey was conducted among 313 patients, 313 carers and 37 providers in this region in a resource-limited setting. Data were collected using a digital questionnaire via Kobo Collect, then cleaned with Excel before analysis with EPI Info software. Frequency analysis and percentage calculations were used for description, while the Chi-square test and Odss Ratio (95% CI) calculations were applied to establish the association between the occurrence of complications and the other variables.
Results: Fewer than 60% of the target facilities applied the WHO-recommended safety protocols, such as the surgical checklist. Post-anaesthetic complications were significantly associated with the absence of postoperative follow-up.
Conclusion: Our study shows that the community's perception of anaesthesia remains negative overall and is influenced by safety levels. This is because patients who have had a negative experience with anaesthesia perceive it as a threat to their health, which makes them negative customers who pose a public danger. Conversely, a positive experience of anaesthesia promotes community outreach based on its benefits and reassures potential surgical patients that their safety is guaranteed by trusting anaesthesia professionals. This study calls for an integrated clinical and community approach to make anaesthesia everyone's business, involving decision-makers, anaesthesia professionals and care recipients. This can be achieved by institutionalising the use of the checklist in all facilities and adapting it to the realities and context of resource-limited areas. Continuing education for anaesthesia practitioners should be reinforced, and a standardised monitoring and evaluation system should be implemented in this sector to guarantee success.
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